Irmgard Una Tackie, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A118539 Issued in CA

Practice address

15290 Summit Ave
Suite B
Fontana, CA 92336-0240

Phone

(909) 225-1900

NPI assigned

Aug 3, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: itackie@gold.pcc-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• San Marcos Medical Group Inc

  • Obstetrics & Gynecology Physician
  • Fontana, CA
  • NPI 1447446448
  Medicare reassignment NPD
• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1215168653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16096 PITZER ST",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923364530",
            "telephone_number": "865-591-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15290 SUMMIT AVE",
            "address_2": "SUITE B",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923360240",
            "telephone_number": "909-225-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKIE",
        "first_name": "IRMGARD",
        "middle_name": "UNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-03",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A118539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "itackie@gold.pcc-direct.com",
            "affiliation": "N",
            "address_1": "15290 Summit Ave",
            "address_2": "Suite B",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923360240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Azeem Abdul Syed, PHARMD
• Azra Syed, MD
• Ibolya Szuromi, M.A.
• Hanieh Sadat Tabatabaei Yeganeh
• Yzabella Marie Tabirara, PHARMD
• Staci Tagawa
• Shahin Taheri, RPH
• Kathleen Takahashi, LVN
• Michael A. Takehara, MD
• Stevie Summer Joy Taken

• Pediatrics Physician in Fontana, CA
• Providers in Fontana, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.